A new perspective on small-scale treatment systems for arsenic affected groundwater

This work provides a new perspective on small-scale treatment systems to remove arsenic from groundwater for potable applications in low-income communities. Data corroborated from the literature highlight a significant challenge to providing potable water in a financially sustainable manner in arsenic affected areas. Analysis of the literature also reveals notable deficiency in the current practice, especially the overfocus on household-scale treatment systems for arsenic affected groundwater without adequate maintenance, monitoring, and a systematic cost–benefit analysis. Accurate and reliable analysis of arsenic in water samples at relevant health guideline values is costly and technologically demanding for low-income communities. Significant discrepancy in the performance of household-scale treatment systems can be attributed to the lack of maintenance and systematic monitoring. Moreover, data on the maintenance and compliance monitoring cost of small-scale arsenic treatment systems are very limited in the literature, and the available data show an exponential increase in maintenance cost per treatment capacity unit as the treatment size decreases. On the other hand, significant opportunities exist to increase performance reliability and reduce water treatment cost by taking advantage of the current digital transformation of the water sector. The analysis in this work suggests the need to reframe current practice towards commune-scale treatment systems as an interim step before centralised water supply is available

Clinically and microbiologically derived azithromycin susceptibility breakpoints for Salmonella enterica serovars Typhi and Paratyphi A.

Azithromycin is an effective treatment for uncomplicated infections with Salmonella enterica serovar Typhi and serovar Paratyphi A (enteric fever), but there are no clinically validated MIC and disk zone size interpretative guidelines. We studied individual patient data from three randomized controlled trials (RCTs) of antimicrobial treatment in enteric fever in Vietnam, with azithromycin used in one treatment arm, to determine the relationship between azithromycin treatment response and the azithromycin MIC of the infecting isolate. We additionally compared the azithromycin MIC and the disk susceptibility zone sizes of 1,640 S. Typhi and S. Paratyphi A clinical isolates collected from seven Asian countries. In the RCTs, 214 patients who were treated with azithromycin at a dose of 10 to 20 mg/ml for 5 to 7 days were analyzed. Treatment was successful in 195 of 214 (91%) patients, with no significant difference in response (cure rate, fever clearance time) with MICs ranging from 4 to 16 μg/ml. The proportion of Asian enteric fever isolates with an MIC of ≤ 16 μg/ml was 1,452/1,460 (99.5%; 95% confidence interval [CI], 98.9 to 99.7) for S. Typhi and 207/240 (86.3%; 95% CI, 81.2 to 90.3) (P < 0.001) for S. Paratyphi A. A zone size of ≥ 13 mm to a 5-μg azithromycin disk identified S. Typhi isolates with an MIC of ≤ 16 μg/ml with a sensitivity of 99.7%. An azithromycin MIC of ≤ 16 μg/ml or disk inhibition zone size of ≥ 13 mm enabled the detection of susceptible S. Typhi isolates that respond to azithromycin treatment. Further work is needed to define the response to treatment in S. Typhi isolates with an azithromycin MIC of >16 μg/ml and to determine MIC and disk breakpoints for S. Paratyphi A